Abstract:
Recent targets for glycemic management in patients with type 2
diabetes mellitus (T2DM) require optimization of dosing strategies for oral
antidiabetics. Metformin is the first choice in the absence of contraindications with
dose-related antihyperglycemic efficacy that extends to daily doses of 2000 mg/day.
So metformin dose titration with appropriate self care practice is the cornerstone
to see the intended antihyperglycemic efficacy of metformin in T2DM.
Objective: To assess the impact of metformin dose titration and self care practices
on glycemic control of T2DM patients at Felege Hiwot Referral Hospital (FRH).
Methods and Participants: A retrospective-general cohort study was conducted.
All T2DM patients who had started metformin from March 01, 2010 to March 31,
2012, and came for follow up at the diabetes mellitus (DM) clinic during the study
period were included. Data were collected by face-to-face interview and medical
chart review. Data were analyzed by SPSS version 20.0. Logistic regression,
Repeated Measures ANOVA, and Kaplan Meier survival analysis were used.
Results: Nineteen (23.7%) of patients were on the metformin dose of 1500 mg and
above, whereas 61 (76.3%) of patients were on metformin dose of less than 1500
mg. Twenty four (30.0%), and twenty three (28.7 %) of the patients had attained
the desired fasting plasma glucose (FPG) level of below 130 mg/dl in the first two,
and six months of metformin therapy respectively. The mean FPG in the first two,
and six months of therapy was 190 mg/dl (standard deviation (SD) = 70.9), and
179.9 mg/dl (SD=57.7) respectively. Titrated form of metformin in the first two
months of therapy had a 70.2%, 66.1% and 70.2% control of FPG than the
untitrated metformin at the two, six and twelve month period respectively.
Conclusion: More than two-third of the participants had suboptimal dose titration
where less than one-third of them had FPG level below130 mg/dl. So practitioners
should practice the titration of metformin during the first two months of therapy
depending on the FPG level of the patients
